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Triple therapy (ICS/LABA/LAMA) in COPD: time for a reappraisal.
Int J Chron Obstruct Pulmon Dis 2018; 13:3971-3981IJ

Abstract

Recently, two "fixed triple" single-inhaler combinations of an inhaled corticosteroid (ICS), a long-acting β2-agonist (LABA), and a long-acting muscarinic antagonist (LAMA) have become available for patients with COPD. This review presents the clinical evidence that led to the approval of these triple therapies, discusses the role of ICS in patients with COPD, and presents data on the relative efficacy of "fixed triple" (ICS/LAMA/LABA) therapy vs LAMA, ICS/LABA, and LAMA/LABA combinations, and summarizes studies in which ICS/LABAs were combined with LAMAs to form "open triple" combinations. Of the five main fixed triple studies completed so far, three evaluated the efficacy and safety of an extrafine formulation of beclometasone dipropionate, formoterol fumarate, and glycopyrronium; the other two studies evaluated fluticasone furoate, vilanterol, and umeclidinium. Overall, compared to LAMA, ICS/LABA, or LAMA/LABA, triple therapy decreased the risk of exacerbations and improved lung function and health status, with a favorable benefit-to-harm ratio. Furthermore, triple therapy showed a promising signal in terms of improved survival. The evidence suggests that triple therapy is the most effective treatment in moderate/severe symptomatic patients with COPD at risk of exacerbations, with marginal if any risk of side effects including pneumonia. Ongoing studies are examining the role of triple therapy in less severe symptomatic patients with COPD and asthma-COPD overlap.

Authors+Show Affiliations

COPD Center, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden, lowie.vanfleteren@vgregion.se. CIRO, Horn, the Netherlands, lowie.vanfleteren@vgregion.se. Department of Respiratory Medicine, Maastricht University Medical Hospital, Maastricht, the Netherlands, lowie.vanfleteren@vgregion.se.COPD Center, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden, lowie.vanfleteren@vgregion.se. Section of Cardiorespiratory and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.Section of Cardiorespiratory and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy.Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30587953

Citation

Vanfleteren, Lowie, et al. "Triple Therapy (ICS/LABA/LAMA) in COPD: Time for a Reappraisal." International Journal of Chronic Obstructive Pulmonary Disease, vol. 13, 2018, pp. 3971-3981.
Vanfleteren L, Fabbri LM, Papi A, et al. Triple therapy (ICS/LABA/LAMA) in COPD: time for a reappraisal. Int J Chron Obstruct Pulmon Dis. 2018;13:3971-3981.
Vanfleteren, L., Fabbri, L. M., Papi, A., Petruzzelli, S., & Celli, B. (2018). Triple therapy (ICS/LABA/LAMA) in COPD: time for a reappraisal. International Journal of Chronic Obstructive Pulmonary Disease, 13, pp. 3971-3981. doi:10.2147/COPD.S185975.
Vanfleteren L, et al. Triple Therapy (ICS/LABA/LAMA) in COPD: Time for a Reappraisal. Int J Chron Obstruct Pulmon Dis. 2018;13:3971-3981. PubMed PMID: 30587953.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Triple therapy (ICS/LABA/LAMA) in COPD: time for a reappraisal. AU - Vanfleteren,Lowie, AU - Fabbri,Leonardo M, AU - Papi,Alberto, AU - Petruzzelli,Stefano, AU - Celli,Bartolome, Y1 - 2018/12/12/ PY - 2018/12/28/entrez PY - 2018/12/28/pubmed PY - 2019/7/2/medline KW - adrenergic β2 receptor agonists KW - chronic obstructive KW - exacerbations KW - glucocorticoids KW - muscarinic antagonists KW - pulmonary disease KW - review KW - safety SP - 3971 EP - 3981 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 13 N2 - Recently, two "fixed triple" single-inhaler combinations of an inhaled corticosteroid (ICS), a long-acting β2-agonist (LABA), and a long-acting muscarinic antagonist (LAMA) have become available for patients with COPD. This review presents the clinical evidence that led to the approval of these triple therapies, discusses the role of ICS in patients with COPD, and presents data on the relative efficacy of "fixed triple" (ICS/LAMA/LABA) therapy vs LAMA, ICS/LABA, and LAMA/LABA combinations, and summarizes studies in which ICS/LABAs were combined with LAMAs to form "open triple" combinations. Of the five main fixed triple studies completed so far, three evaluated the efficacy and safety of an extrafine formulation of beclometasone dipropionate, formoterol fumarate, and glycopyrronium; the other two studies evaluated fluticasone furoate, vilanterol, and umeclidinium. Overall, compared to LAMA, ICS/LABA, or LAMA/LABA, triple therapy decreased the risk of exacerbations and improved lung function and health status, with a favorable benefit-to-harm ratio. Furthermore, triple therapy showed a promising signal in terms of improved survival. The evidence suggests that triple therapy is the most effective treatment in moderate/severe symptomatic patients with COPD at risk of exacerbations, with marginal if any risk of side effects including pneumonia. Ongoing studies are examining the role of triple therapy in less severe symptomatic patients with COPD and asthma-COPD overlap. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/30587953/Triple_therapy_(ICS/LABA/LAMA)_in_COPD:_time_for_a_reappraisal L2 - https://dx.doi.org/10.2147/COPD.S185975 DB - PRIME DP - Unbound Medicine ER -